340B Drug Pricing Program Database


DSH430016X AVERA MCKENNAN (Active) - information as of 4/28/2025 1:47:09 AM

Main Details
AVERA MCKENNAN
Avera Medical Group Pediatrics - Marion Rd.
Disproportionate Share Hospital
Yes
DSH430016X
430016


Additional Details
Active
2/7/2013
4/1/2013
2/28/2013
8/28/2024

Contacts

Avera
Melissa Goff, Vice President - Pharmacy
(605) 322-8548

Avera
Brandy Friesen, Pharmacy Regulatory Analyst
(605) 322-8446

Addresses

2100 S MARION RD
STE 205
SIOUX FALLS, SD 57106

Avera McKennan Hospital
PO BOX 5045
Sioux Falls, SD 57117


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Avera McKennan Hospital
1325 S Cliff Avenue
Sioux Falls, SD 57105

AVERA DISTRIBUTION CENTER
3301 N 1ST AVE
SIOUX FALLS, SD 57104

Avera Medical Group Pediatrics - Marion Rd.
2100 S Marion Rd
Ste 205
Sioux Falls, SD 57106

Avera McKennan dba Avera on Louise Inpatient Pharmacy
6100 S Louise Ave
Suite B300
Sioux Falls, SD 57108

Avera Pharmacy Distribution Center
4101 W Memory Circle, Ste 150
Sioux Falls, SD 57107
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH430016AChildDSHAVERA MCKENNANAvera Medical Group Internal Medicine1301 S CLIFF AVESIOUX FALLSSDActive
DSH430016AAChildDSHAVERA MCKENNANAvera Medical Group Family Medicine - Marion Rd2100 S Marion RdSioux FallsSDActive
DSH430016ABChildDSHAVERA MCKENNANAvera Medical Group McGreevy - West Benson Rd4011 W Benson RdSioux FallsSDActive
DSH430016ACChildDSHAVERA MCKENNANAvera Medical Group Tea725 E Figzel CourtTeaSDActive
DSH430016ADChildDSHAVERA MCKENNANAvera Medical Group Urogynecology6100 S Louise AveSioux FallsSDActive
DSH430016AEChildDSHAVERA MCKENNANAvera Brain & Spine Institute1301 S CLIFF AVESIOUX FALLSSDTerminated
DSH430016AFChildDSHAVERA MCKENNANAvera Medical Group Gastroenterology6100 S Louise AveSIOUX FALLSSDActive
DSH430016AGChildDSHAVERA MCKENNANAvera Transplant & Liver Surgery911 E 20th StSioux FallsSDActive
DSH430016AHChildDSHAVERA MCKENNANAvera Medical Group Obstetrics & Gynecology1417 S CLIFF AVESIOUX FALLSSDActive
DSH430016AJChildDSHAVERA MCKENNANAvera Medical Group Certified Nurse Midwifery1417 S CLIFF AVESioux FallsSDActive
DSH430016AKChildDSHAVERA MCKENNANAvera Medical Group Radiology - Diagnostic1000 E 23rd StreetSioux FallsSDActive
DSH430016ALChildDSHAVERA MCKENNANAvera Medical Group Radiology - CT Scan1301 S Cliff AveSioux FallsSDActive
DSH430016AMChildDSHAVERA MCKENNANAvera Medical Group Radiology - PET1000 E 23rd StSioux FallsSDActive
DSH430016ANChildDSHAVERA MCKENNANAvera Medical Group Internal Medicine Women's Clinic6215 South Cliff AveSioux FallsSDActive
DSH430016APChildDSHAVERA MCKENNANAvera Medical Group Obstetrics & Gynecology - Cliff Ave.6215 S Cliff AveSioux FallsSDActive
DSH430016AQChildDSHAVERA MCKENNANAvera Medical Group Obstetrics & Gynecology- Marion Rd.2100 S Marion RdSioux FallsSDActive
DSH430016ARChildDSHAVERA MCKENNANEmergency Department West2100 S Marion RdSioux FallsSDActive
DSH430016ASChildDSHAVERA MCKENNANAvera Orthopedics6100 S Louise AveSioux FallsSDActive
DSH430016ATChildDSHAVERA MCKENNANPain Clinic1301 S Cliff AveSioux FallsSDActive
DSH430016AUChildDSHAVERA MCKENNANAvera Medical Group Plastic & Reconstructive Surgery1417 S CLIFF AVESIOUX FALLSSDActive
DSH430016AVChildDSHAVERA MCKENNANAvera Digestive Disease Institute - Endoscopy/Colonoscopy6100 S Louise AveSioux FallsSDActive
DSH430016AWChildDSHAVERA MCKENNANAvera Medical Group Orthopedics & Sports Medicine911 E 20th StreetSioux FallsSDActive
DSH430016AXChildDSHAVERA MCKENNANMcKennan Outpatient Infusion1417 S Cliff AvenueSioux FallsSDActive
DSH430016AYChildDSHAVERA MCKENNANAvera Medical Group Internal Medicine - Louise Ave6100 S. Louise AveSioux FallsSDActive
DSH430016AZChildDSHAVERA MCKENNANAvera Medical Group Infectious Disease Specialists6709 S Minnesota AveSioux FallsSDActive
DSH430016BChildDSHAVERA MCKENNANAvera Medical Group Oncology & Hematology1000 E 23RD STSIOUX FALLSSDActive
DSH430016BAChildDSHAVERA MCKENNANAvera Medical Group - Maternal Fetal Medicine1417 S Cliff AveSioux FallsSDActive
DSH430016BBChildDSHAVERA MCKENNANAvera Medical Group - Pediatric Specialists1417 S Cliff AvenueSioux FallsSDActive
DSH430016BCChildDSHAVERA MCKENNANNeuro Endovascular1301 S Cliff AveSioux FallsSDActive
DSH430016BDChildDSHAVERA MCKENNANNeuro Critical Care1301 S Cliff AveSioux FallsSDActive
DSH430016BEChildDSHAVERA MCKENNANNeurosurgery1301 S Cliff AveSioux FallsSDActive
DSH430016BFChildDSHAVERA MCKENNANAvera Medical Group Neurology1301 S Cliff AveSioux FallsSDActive
DSH430016BGChildDSHAVERA MCKENNANAvera Medical Group Dermatology - Marion Rd2100 S Marion RdSioux FallsSDActive
DSH430016BHChildDSHAVERA MCKENNANAvera Medical Group - Breast Oncology1000 E 23rd StSioux FallsSDActive
DSH430016BJChildDSHAVERA MCKENNANAvera Medical Group - Dermatology - Dawley Farms1600 S Highline AveSioux FallsSDActive
DSH430016BKChildDSHAVERA MCKENNANAvera Medical Group - Internal Medicine - Dawley Farms1600 S Highline AveSioux FallsSDActive
DSH430016BLChildDSHAVERA MCKENNANAvera Medical Group - Family Practice - Dawley Farms1600 S Highline AveSioux FallsSDActive
DSH430016BMChildDSHAVERA MCKENNANAvera Medical Group Orthopedics - Hand Clinic6100 S Louise AveSioux FallsSDActive
DSH430016BNChildDSHAVERA MCKENNANAvera Medical Group Obstetrics - Dawley Farms1600 South Highline AveSioux FallsSDActive
DSH430016BPChildDSHAVERA MCKENNANAvera Medical Group Pediatrics Dawley Farms - Pediatrics1600 South Highline AveSioux FallsSDActive
DSH430016BQChildDSHAVERA MCKENNANAvera Medical Group - Maternal Fetal Medicine - Dawley Farm1600 Highline AveSioux FallsSDActive
DSH430016BRChildDSHAVERA MCKENNANAvera Medical Group - ENT1417 S Cliff AveSioux FallsSDActive
DSH430016BSChildDSHAVERA MCKENNANAvera Medical Group - Comprehensive Breast1000 E 23rdSioux FallsSDActive
DSH430016BTChildDSHAVERA MCKENNANAvera Medical Group - Radiation Oncology1000 E 23rdSioux FallsSDActive
DSH430016BUChildDSHAVERA MCKENNANAvera Comprehensive Weight Management6000 W 41st StSioux FallsSDActive
DSH430016BVChildDSHAVERA MCKENNANED East - Emergency Room1600 S Highline AveSioux FallsSDActive
DSH430016BWChildDSHAVERA MCKENNANAvera on Louise - Outpatient Surgery6100 S Louise AveSioux FallsSDActive
DSH430016BXChildDSHAVERA MCKENNANAvera Dialysis4210 West 53rd StSioux FallsSDActive
DSH430016BYChildDSHAVERA MCKENNANAvera Behavioral Health - Partial Hospital Program4400 W 69th StSioux FallsSDActive
DSH430016BZChildDSHAVERA MCKENNANAvera Dialysis - Brookings - Renal Therapy300 22nd AveBrookingsSDActive
DSH430016CChildDSHAVERA MCKENNANAvera Medical Group Hematology, Transplant & Cellular Therapy1000 E 23RD STSIOUX FALLSSDActive
DSH430016CAChildDSHAVERA MCKENNANAvera Dialysis - Milbank - Renal Therapy301 Flynn DrMilbankSDActive
DSH430016CBChildDSHAVERA MCKENNANAvera Dialysis - Mitchell - Renal Therapy1900 Grassland DriveMitchellSDActive
DSH430016CCChildDSHAVERA MCKENNANNew Hope Dialysis Center - Renal Therapy310 W SD Hwy 46WagnerSDActive
DSH430016DChildDSHAVERA MCKENNANAvera Medical Group Pulmonary & Sleep Medicine1301 S CLIFF AVESIOUX FALLSSDActive
DSH430016EChildDSHAVERA MCKENNANAvera Nephrology Plaza 2 & 4911 E 20th StSioux FallsSDActive
DSH430016FChildDSHAVERA MCKENNANAvera Endocrinology & Diabetes1600 S. Highline AveSioux FallsSDActive
DSH430016GChildDSHAVERA MCKENNANAvera Therapy1301 S CLIFF AVESIOUX FALLSSDActive
DSH430016HChildDSHAVERA MCKENNANAvera Medical Group Rheumatology6100 S Louise AveSioux FallsSDActive
DSH430016JChildDSHAVERA MCKENNANAvera Medical Group Behavioral Health - Children4400 W 69TH STREETSIOUX FALLSSDActive
DSH430016KChildDSHAVERA MCKENNANAvera Medical Group Behavioral Health - Adult4400 W 69TH STSIOUX FALLSSDActive
DSH430016LChildDSHAVERA MCKENNANAvera Medical Group Gynecologic Oncology1000 E 23RD STSioux FallsSDActive
DSH430016MChildDSHAVERA MCKENNANAvera Medical Group Eye Care911 East 20th St.Sioux FallsSDTerminated
DSH430016NChildDSHAVERA MCKENNANAvera Medical Group Dermatology6701 S Minnesota AveSioux FallsSDActive
DSH430016PChildDSHAVERA MCKENNANAvera Liver Disease1600 S. Highline AveSioux FallsSDActive
DSH430016RChildDSHAVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERAvera Medical Group McHale Institute3720 W 69th Street # 1Sioux FallsSDTerminated
DSH430016SChildDSHAVERA MCKENNANAvera Medical Group McGreevy - 69th and Western1910 W 69th StSioux FallsSDActive
DSH430016TChildDSHAVERA MCKENNANAvera Medical Group McGreevy - 7th Ave1200 S 7th AveSioux FallsSDActive
DSH430016UChildDSHAVERA MCKENNANAvera Medical Group McGreevy - Brandon1101 E Holly BlvdBrandonSDActive
DSH430016VChildDSHAVERA MCKENNANAvera Medical Group McGreevy - Dawley Farm1035 S HIGHLINE PLACESIOUX FALLSSDTerminated
DSH430016WChildDSHAVERA MCKENNANAvera Medical Group Harrisburg220 S Cliff AveHarrisburgSDActive
DSH430016XChildDSHAVERA MCKENNANAvera Medical Group Pediatrics - Marion Rd.2100 S MARION RDSIOUX FALLSSDActive
DSH430016ZChildDSHAVERA MCKENNANAvera Medical Group Family Medicine - Cliff Ave.6215 S CLIFF AVESioux FallsSDActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressDeleteGroup Change RequestAvera McKennan 3820 N Potsdam Ave Ste 3 Sioux Falls, SD 57104 4/8/2025 1:53 PM
AddressesShipping AddressInsertGroup Change Request Avera Pharmacy Distribution Center 4101 W Memory Circle, Ste 150 Sioux Falls, SD 571074/8/2025 1:53 PM
DetailsLast Recertification DateUpdateRecertification9/6/2023 3:53:24 PM8/28/2024 11:21:10 AM8/28/2024 11:21 AM
AddressesShipping AddressInsertRecertification Avera Medical Group Pediatrics - Marion Rd. 2100 S Marion Rd Ste 205 Sioux Falls, SD 571069/6/2023 3:53 PM
AddressesShipping AddressInsertRecertification Avera McKennan 3820 N Potsdam Ave Ste 3 Sioux Falls, SD 571049/6/2023 3:53 PM
AddressesShipping AddressInsertRecertification Avera McKennan dba Avera on Louise Inpatient Pharmacy 6100 S Louise Ave Suite B300 Sioux Falls, SD 571089/6/2023 3:53 PM
DetailsLast Recertification DateUpdateRecertification9/14/2022 10:13:04 AM9/6/2023 3:53:24 PM9/6/2023 3:53 PM
DetailsLast Recertification DateUpdateRecertification9/2/2021 3:47:47 PM9/14/2022 10:13:04 AM9/14/2022 10:13 AM
DetailsLast Recertification DateUpdateRecertification8/31/2020 1:26:34 PM9/2/2021 3:47:47 PM9/2/2021 3:47 PM
ContactsAuthorizing OfficialUpdateChange RequestPetersen, Steve Vice President of Pharmacy Avera 6053228313Goff, Melissa Vice President - Pharmacy Avera 60532285485/24/2021 7:02 PM
ContactsPrimary ContactUpdateProfile Change RequestFriesen, Brandy 340b Coordinator Avera 6053228446Friesen, Brandy Pharmacy Regulatory Analyst Avera 60532284464/28/2021 1:48 PM
DetailsLast Recertification DateUpdateRecertification9/5/2019 7:12:06 AM8/31/2020 1:26:34 PM8/31/2020 1:26 PM
DetailsLast Recertification DateUpdateRecertification9/12/2018 3:20:56 PM9/5/2019 7:12:06 AM9/5/2019 7:12 AM
DetailsEntity SubnameUpdateRecertificationAMG MCGREEVY PEDIATRICSAvera Medical Group Pediatrics - Marion Rd.9/5/2019 7:12 AM
AddressesShipping AddressInsertRecertification Avera McKennan Hospital 1325 S Cliff Avenue Sioux Falls, SD 571059/12/2018 3:20 PM
AddressesShipping AddressInsertRecertification AVERA DISTRIBUTION CENTER 3301 N 1ST AVE SIOUX FALLS, SD 571049/12/2018 3:20 PM
AddressesMain AddressUpdateRecertification Suite 205 2100 S Marion Road Sioux Falls, SD 57106 2100 S MARION RD STE 205 SIOUX FALLS, SD 571069/12/2018 3:20 PM
AddressesShipping AddressDeleteRecertificationAvera McKennan Hospital 1325 S Cliff Ave Sioux Falls, SD 57105 9/12/2018 3:20 PM
DetailsLast Recertification DateUpdateRecertification11/16/2017 11:19:53 AM9/12/2018 3:20:56 PM9/12/2018 3:20 PM
DetailsEntity SubnameUpdateRecertificationAvera Medical Group McGreevy Pediatrics SouthAMG MCGREEVY PEDIATRICS9/12/2018 3:20 PM
DetailsEntity NameUpdateRecertificationAVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTERAVERA MCKENNAN9/5/2018 12:00 PM
ContactsAuthorizing OfficialUpdateChange RequestFlicek, David Avera McKennan President/CEO Avera McKennan 6053227916Petersen, Steve Vice President of Pharmacy Avera 605322831312/27/2017 2:32 PM
ContactsPrimary ContactInsertRecertification Friesen, Brandy 340b Coordinator Avera 605322844611/16/2017 11:19 AM
DetailsLast Recertification DateUpdateRecertification8/25/2016 12:00:00 AM11/16/2017 11:19:53 AM11/16/2017 11:19 AM
ContactsAuthorizing OfficialUpdate Flicek, David Avera McKennan President/CEO 6053227916Flicek, David Avera McKennan President/CEO Avera McKennan 605322791610/12/2017 5:09 PM
ContactsSigned ByInsert  KAPASKA, DAVE REGIONAL PRESIDENT/CEO 60532278088/3/2017 11:37 AM
ContactsAuthorizing OfficialInsert  Flicek, David Avera McKennan President/CEO 60532279168/3/2017 11:37 AM
AddressesMain AddressInsert   Suite 205 2100 S Marion Road Sioux Falls, SD 571068/3/2017 11:37 AM
AddressesBilling AddressInsert  Avera McKennan Hospital PO BOX 5045 Sioux Falls, SD 571178/3/2017 11:37 AM
AddressesShipping AddressInsert  Avera McKennan Hospital 1325 S Cliff Ave Sioux Falls, SD 571058/3/2017 11:37 AM
DetailsLast Recertification DateUpdate 8/26/2015 12:00:00 AM8/25/2016 12:00:00 AM8/25/2016 12:33 PM
DetailsLast Recertification DateUpdate 8/12/2014 12:00:00 AM8/26/2015 12:00:00 AM8/26/2015 2:22 PM
DetailsLast Recertification DateUpdate 9/6/2013 12:00:00 AM8/12/2014 12:00:00 AM8/12/2014 11:31 AM
DetailsLast Recertification DateUpdate  9/6/2013 12:00:00 AM9/6/2013 6:51 AM
Details340B IDUpdate ISAPDSH430016XDSH430016X2/28/2013 3:17 PM
DatesParticipating Approval DateUpdate  2/28/2013 12:00:00 AM2/28/2013 3:17 PM
DetailsStateUpdate PendingActive2/28/2013 3:17 PM
DatesStart DateUpdate  4/1/2013 12:00:00 AM2/28/2013 3:17 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REGISAPDSH430016X2/8/2013 8:33 AM
DetailsLast Recertification DateInsert   2/7/2013 3:20 PM
DetailsGrant NumberInsert   2/7/2013 3:20 PM
Details340B IDInsert  OUTPATIENT_ONLINE_REG2/7/2013 3:20 PM
DetailsIs Authorizing Official EHB DataInsert   2/7/2013 3:20 PM
DatesLast Date That 340B Drugs PurchasedInsert   2/7/2013 3:20 PM
DetailsMedicare Provider NumberInsert  4300162/7/2013 3:20 PM
DetailsEntity NameInsert  AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTER2/7/2013 3:20 PM
DetailsProgram CodeInsert  DSH2/7/2013 3:20 PM
DetailsEntity SubnameInsert  Avera Medical Group McGreevy Pediatrics South2/7/2013 3:20 PM
DatesParticipating Approval DateInsert   2/7/2013 3:20 PM
DetailsStateInsert  Pending2/7/2013 3:20 PM
DatesRegistration DateInsert  2/7/2013 12:00:00 AM2/7/2013 3:20 PM
DatesSigned By DateInsert  2/7/2013 12:00:00 AM2/7/2013 3:20 PM
DatesStart DateInsert   2/7/2013 3:20 PM
TerminationsTermination CommentsInsert   2/7/2013 3:20 PM
TerminationsTermination DateInsert   2/7/2013 3:20 PM
TerminationsTermination Effective DateInsert   2/7/2013 3:20 PM
TerminationsTermination ReasonInsert   2/7/2013 3:20 PM